<%@ include file="../../common/taglibs.jsp"%>
<div class="left">
	<form:errors path="initialComplaint.complainantName" cssClass="fieldError"/>
    <form:input path="initialComplaint.complainantName" id="complainantName"/>
    <label for="initialComplaint.complainantName"><fmt:message key="user.username"/></label>
</div>    
<div class="left">
	<form:errors path="initialComplaint.complainantEmail" cssClass="fieldError"/>
    <form:input path="initialComplaint.complainantEmail" id="complainantEmail"/>
    <label for="complainantEmail"><fmt:message key="user.email"/></label>
</div>    
<div class="left">
	<form:errors path="initialComplaint.complainantAddress" cssClass="fieldError"/>
    <form:input path="initialComplaint.complainantAddress" id="complainantAddress"/>
    <label for="initialComplaint.complainantAddress"><fmt:message key="user.address"/></label>
</div>    
<div class="left">
    <form:errors path="initialComplaint.complainantCity" cssClass="fieldError"/>
    <form:input path="initialComplaint.complainantCity" id="complainantCity"/>
    <label for="initialComplaint.complainantCity"><fmt:message key="user.city"/></label>
</div>    
<div class="left">
	<form:select id="initialComplaint.complainantStateLkp.stateId" multiple="false" path="initialComplaint.complainantStateLkp.stateId">
		<form:options items="${stateList}" itemLabel="value" itemValue="id"/>
    </form:select>
    <label for="initialComplaint.complainantStateLkp.stateId"><fmt:message key="user.state"/></label>
</div>    
<div class="left">
	<form:errors path="initialComplaint.complainantZip" cssClass="fieldError"/>
    <form:input path="initialComplaint.complainantZip" id="complainantZip" maxlength="5"/>
    <label for="initialComplaint.complainantZip"><fmt:message key="user.zip"/></label>
</div>    
<div class="left">
	<form:errors path="initialComplaint.complainantPhone" cssClass="fieldError"/>
    <form:input path="initialComplaint.complainantPhone" id="complainantPhone" onblur="return formatComplainantPhone(this);"/>
    <label for="initialComplaint.complainantPhone"><fmt:message key="user.phone"/></label>&nbsp;
    <form:input path="initialComplaint.complainantPhoneExt" id="complainantPhoneExt" size="6" maxlength="6"/>
    <label for="initialComplaint.complainantPhoneExt"><fmt:message key="business.phone.ext"/></label>
</div>